title: Utilization of cardiothoracic surgeons for operative penetrating thoracic trauma and its impact on clinical outcomes.
abstract: BACKGROUND
  Large series reporting outcomes for penetrating thoracic trauma have identified injury pattern and injury severity scoring as predictors of poor outcome. However, the impact of surgical expertise on patient outcomes has not been previously investigated. We sought to determine how often board-certified cardiothoracic surgeons are utilized for operative thoracic trauma and whether this has an effect on patient outcomes.
  
  
  METHODS
  A level I trauma center registry was queried between 2003 and 2011. Records of patients undergoing surgery as a result of penetrating thoracic trauma were retrospectively reviewed. Patient demographics, injuries, injury severity, utilization of a cardiothoracic surgical operative consult and outcomes were recorded. Patients operated on by cardiothoracic surgeons were compared with patients operated on by trauma surgeons using stepwise multivariate analyses to determine the factors associated with utilization of cardiothoracic surgeons for operative thoracic trauma and survival.
  
  
  RESULTS
  Cardiothoracic surgeons were used in 73.0% of cases (162 of 222) over the study period. The use of cardiothoracic surgeons increased incrementally both overall (38.5% to 73.9%), and for emergent/urgent cases (31.8% to 73.3%). When comparing patients undergoing operation on an emergent/urgent basis by cardiothoracic versus trauma surgeons, there was no significant difference with regard to demographics, mechanism of injury, injury severity scoring, or surgical morbidity. Stepwise logistic regression showed the presence of a cardiothoracic surgeon to be independently associated with survival (odds ratio 4.70; p = 0.019).
  
  
  CONCLUSIONS
  Use of cardiothoracic surgeons for operative thoracic trauma increased over the study period. Outcomes for severely injured patients with elevated chest injury scores or decreased revised trauma scores may be improved with appropriate operative consultation with a board-certified cardiothoracic surgeon.
authors.affiliation: Division of Cardiothoracic Surgery, University of Washington Medical Center, Seattle, Washington 98195-6310, USA. nmollb@uw.edu
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Mollberg
authors.forename: Deborah
authors.initials: D
authors.lastname: Tabachnik
authors.forename: Farhood
authors.initials: F
authors.lastname: Farjah
authors.forename: Fang-Ju
authors.initials: FJ
authors.lastname: Lin
authors.forename: Amir
authors.initials: A
authors.lastname: Vafa
authors.forename: Khaled
authors.initials: K
authors.lastname: Abdelhady
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Merlotti
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Wood
authors.forename: Malek G
authors.initials: MG
authors.lastname: Massad
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000601:surgery*; D013903:Thoracic Surgery / Q000706:statistics & numerical data*; D019616:Thoracic Surgical Procedures; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000601:surgery*
keywords: 11; 5